On June 20, 2024, United States Attorney Brandon B. Brown announced that a 51-year-old woman had been sentenced for conspiracy to commit healthcare fraud and three counts of healthcare fraud. She was sentenced to 72 months in prison, followed by 3 years of supervised release and was also ordered to pay $3,675,948.42 in restitution.
The defendant was the owner of a Louisiana corporation that purported to provide hospice services in Lafayette Parish and other parishes in the Western District of Louisiana. Through evidence presented at trial, jurors learned that from approximately 2009 through 2017, over 24 patients were placed on hospice by the defendant’s company without meeting the criteria required by Medicare.
During the time period that the patients were on hospice and under the care and supervision of the company, none of them had been diagnosed with a terminal condition. In fact, many of the patients themselves, who are still alive and thriving many years later, as well as family members of other patients, testified that they never knew that they had been placed on hospice.
One of the patients testified at trial that Medicare refused to cover a procedure he needed to have, because unbeknownst to him, he was listed as a hospice patient. Many of these patients thought they were receiving some type of home health or free services, rather than being placed on hospice.
Testimony at trial revealed that while on hospice care, many of the patients were living normal lives and although most of them did have medical conditions, none had been diagnosed as having a terminal condition. Evidence was introduced proving that there were patients who had been on hospice for more than five years and at the time of trial, were still alive.
US Attorney Brandon B. Brown said, “The defendant in this case took advantage of elderly patients for the benefit of her company as opposed to her clients. We believe this is a fair sentence and we will continue to prosecute cases of fraud and corruption by those who seek to unjustly enrich themselves to the detriment of the elderly and federal government.”
Compliance Perspective
Issue
All medical services that are provided must be medically necessary, and the patient or resident must be eligible for the services that are provided and involved in the decision to choose those services. Individuals receiving hospice services must meet specific criteria to be eligible for the program, including having less than six months to live. Providing medical services that are not necessary can be considered a false claim. Failure to promptly report a false claim or a kickback can result in lawsuits, fines, and other sanctions.
Discussion Points
- Review policies and procedures related to hospice services to ensure they are accurate and current. Update policies as needed.
- Train staff on the criteria that must be met to enroll a resident into the hospice program. Additionally, train nursing staff and social services on the procedure to follow for receiving or making hospice referrals. Document that these trainings occurred and file each signed document in the employee’s education file.
- Periodically audit to ensure that residents enrolled in hospice programs meet eligibility criteria, and that documentation is sufficient to support the need for hospice services.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
